Health data standards and systems

We have come across several patients having "biventricular" pacemaker insertions, and are not sure how to code them!

The device is programmed as DDDR, and 2 ventricular leads are inserted - one in the left ventricle, and one in the right ventricle.
We coded insertion of DDD 38281-10 [651], and insertion of electrode into ventricle x 2 38278-01 [648] - but this groups to F17Z Pacemaker replacement.

Any suggestions?

Search Details:
We checked on the internet site: heartcentreonline.com which gives good details on the biventricular pacemaker procedure - stating 2 leads are inserted - one into each ventricle.
No queries could be found on the NCCH coding query database.

A biventricular pacemaker is a triple chamber device and has three leads - two ventricular leads, and one atrial lead. These devices should not be coded as a dual chamber device. The correct code to use in ICD-10-AM 3rd edition is:
Insertion
-pacemaker
--cardiac
---permanent 38281-00 [652]
'38281-00 Insertion of chamber pacemaker, not elsewhere classified'
Insertion
-electrode(s) lead(s)
--heart (cardiac) (for)
---pacemaker
----permanent
-----transvenous
------atrium 38278-00 [648]
-------and ventricle 38284-00 [648]

'38284-00 [648] Insertion of permanent dual chamber transvenous electrodes (Insertion of permanent transvenous electrodes into atrium and ventricle)'

Care should be taken when coding replacement of pacemakers, as the number of leads may vary depending on whether or not some are retained.

Biventricular pacemakers can also have an automatic implantable cardioverter defibrillator (AICD) component. Coders should investigate documentation of the device details to determine the type of device. If there is an ICD component to the pacemaker, then it should be coded as an AICD.

There will be a specific code in ICD-10-AM 4th edition for a biventricular pacemaker.